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This study examined the level of involvement by local health departments (LHDs) in practice-based research (PBR) activities, and determined factors associated with variation in such involvement.
Large public health agencies may be overrepresented, raising the risk that research results may not adequately address the needs, uncertainties, and innovations arising in smaller settings. Correcting this imbalance may require mechanisms for greater involvement of low-resource LHDs in PBR and expanded federal support for such activities through PBR networks.